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NEW YORK CITY HOSPITALS: Trauma Centers See Case Shortage

Too many trauma centers and not enough trauma victims are "proving troublesome" for a $250 million-a-year New York City business, today's New York Times reports. During the late 1980s and early 1990s, "a steady stream of mugging, knifing and gunshot victims" led to the "creation of 17 'level one' trauma centers -- costly, up-to-date units that keep teams of elite surgeons and nurses on call to treat the most severe injuries." But, according to the Times, a 20% drop in trauma victims in the city between 1993 and 1996 and the 50% drop in gunshot wound victims have resulted in "too many centers" being "underworked." While "the city's busiest trauma center" --Kings County Medical Center in Brooklyn -- treated 2,600 cases in 1991, the number had dropped to 1,600 cases in 1996. The Bronx's Lincoln Hospital saw trauma cases fall from 2,300 in 1993 to 1,500 in 1996.

Trauma Victim Shortage The patient shortage, according to some experts, "could actually be compromising the level of care." Dr. Marcel Martin, outgoing director of Staten Island University Hospital's trauma center, said the "lack of trauma patients ... forced him to use more cadavers to educate medical students." And "[t]rauma surgeons at several of New York's busiest centers said that patient volume is dropping or has reached a plateau." Kings County Medical Center had a patient load decrease of 40% in the past five years. "They used to say we saw more than most men who went through Vietnam," said Dr. Lisa Patterson, director of Kings County's trauma center. "New Year's Eve used to be just nonstop. I was on call this New Year's Eve, and we had one case after midnight. That's it." The Times reports that "New York's situation ... is not unique" -- hospitals are experiencing "a nationwide drop in the number of trauma patients."

The Future Of Excess The Times reports that Dr. David Boyd, inventor of the trauma system concept, said the problem lies in the excess number of centers: "You have too many pretenders in the system and it dilutes patient care. They're wasting money and they're misrepresenting trauma care to the community." But Dr. Rodger Yurt, a trauma surgeon at New York Cornell Medical Center and chair of the city's Trauma Advisory Committee, "said that New York's congested streets and high- rises -- which render helicopters impractical -- make it prudent to have more trauma centers per capita than elsewhere." The Times notes that the city's "17 centers in the five boroughs ... serve a population of roughly 7.2 million," compared to the six level-one centers that "serve the 9.1 million people in Los Angeles County." Dr. Ronald Simon, trauma center director of Jacobi Hospital, "predicted that increased competition would inevitably lead to fewer hospitals and fewer trauma centers." He said, "I think with the changes in health care, some hospitals are going to survive and some aren't. In order to survive, you have to hustle." But Dr. Unsup Kim, director of Elmhurst Hospital's trauma center, "predicted that the system would remain essentially unchanged, given the concentration of prestigious medical schools and powerful hospitals, and the politics of the health care industry." Kim said, "All the trauma centers have affiliations with large institutions. I don't see it happening in New York" (Rohde, 4/20).

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